HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONy...1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'�'CI BE ACCEPTED
——Dateo1 \. \d � � -\— — ;; '... .
Permit'Number:
Building Permit Application RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 . ST. Lucie County, P rmitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line q�LO"^ 5cteaN
. R+hw� slab
PROPOSED'IIVIPROVEMENT LOCATION:,,
Address: o'Z e�I� jj o �e1 CP L d Q S I. BY
Legal Description: �_��(=� (1 1 Y%d�� t L �� 'St Lucie I
PropertyTaxlD#: �Jv�—hQ�—(92$i�=0.t�` _/
(, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Slob u°-�HK �25oo`p5t)'w� .bet-. film $" �4�t �Za-.Co ?r�%i k,3M)AaW,CF'Q0 l
CONSTRUCTION' INFORMATION:
_
-
Additional work to be e orme un ert Ispermlt—c ec a appy:
❑HVAC �GasTank ❑Gas
Piping Shutters Windows/Doors
[RiElectric 0 Plumbing
Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: `&jtZ S Ft, of First Floor:
Cost of Construction: $ q ��� Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE: . ° ..
CONTRACTOR: ' �-
r
Name o
4J
Name: UPN� Cp
Address:_02 I-) X idt I I )hI_
Company: d [e ;l - c
City: p C State: E-
Address: i �L{(7 S�y Ki l d-
Zip Co e: _d�� rj Fax:
City: i KC'%_ 1 Stater
Phone No.1b(-, -6j7��
Zip Code: Fax:
E-Mail:
Phone No. t'�})-- A 2 fR
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License: C �11(
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ED
ount
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
>,.
-DESIGNER%ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: —Not Applicable
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any Home Owners Association bylaws
applicable rules, or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming poo ces, walls, signs, screen rooms and accessory uses to another n n-res" ential use
allure til RRecord a Notice of Commencement may result i our paying Ice for
improvements to your propy. A Notice of Commencement must be recorded a posted on the jobsite
WARNING TO OWNER: YouNia
before the first inspection.ou intend''to obtain financing, consult with lender o an attorney b fore
commencingwork or ecorur Notice of Commencement.
Signature AOwner/ LesseejC" as Agent for Owner
Signature of Contractor/Ucens Ho er
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF I f )C�,1�
COUNTYOF
The fj�rgping inst ent was acknowledge before me
this ay of�20� by
The for ing instrument was acknowledge efore me
thisdayof� 20�by
�CCI)ALIn�c yCO
el mscO
Name of perso making statement
Name of persn making statement
Personally Known ✓ OR Produced Identification
Personally Known �r// OR Produced Identification
Type of [den tion
'
Type of Identification
Produced
AA
Produced
(Signature of NotaWPubTlic- of Florida
(Signature of Notary Public -State of FloridaCommission
No.KARE��I1IELENCommission
of FI n a otary Public
ommission # GG 207484
Commission Expires
No.te NIELYEN
lorida-Notar PubliMy
sion # GG 207484
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SUPERVISOR
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,12, 2022REVIEWS
REVIEW
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DATE
RECEIVED
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DATE
COMPLETED
Rev. 8/2/17